Fecha de Emisión

21920 Biopsy, soft tissue of back or flank; superficial 21925 deep

21930 Excision, tumor, soft tissue of back or flank, subcutaneous; less than 3 cm 21931 3 cm or greater

21932 Excision, tumor, soft tissue of back or flank, subfascial (eg, intramuscular); less than 5 cm

21933 5 cm or greater

21935 Radical resection of tumor (eg, sarcoma), soft tissue of back or flank; less than 5 cm

21936 5 cm or greater

SPINE (VERTEBRAL COLUMN)

Cervical, thoracic, and lumbar spine.

Within the SPINE section, bone grafting procedures are reported separately and in addition to arthrodesis. For bone grafts in other Musculoskeletal sections, see specific code(s) descriptor(s) and/or accompanying guidelines.

To report bone grafts performed after arthrodesis, see codes 20931-20938. Do not append modifier –62 to bone graft codes 20900 – 20938. Example: Posterior

arthrodesis of L5-S1 for degenerative disc disease utilizing morselized autogenous iliac bone graft harvested through a separate fascial incision. Report as 22612 and 20937. Within the SPINE section, instrumentation is reported separately and in addition to arthrodesis. To report instrumentation procedures performed with definitive vertebral procedure(s), see codes 22840-22855. Instrumentation procedure codes 22840-22848 and 22851 are reported in addition to the definitive procedure(s). The modifier –62 may not be appended to the definitive add-on spinal instrumentation procedure code(s) 22840 – 22848 and 22850-22852. Example: Posterior arthrodesis of L4-S1, utilizing morselized autogenous iliac bone graft harvested through separate fascial incision, and pedicle screw fixation. Report as 22612, 22614, 22842 and 20937.

Vertebral procedures are sometimes followed by arthrodesis and in addition may include bone grafts and instrumentation. When arthrodesis is performed addition to another procedure, the arthrodesis should be reported in addition to the original procedure. Examples are after osteotomy, fracture care, vertebral corpectomy and laminectomy. Since bone grafts and instrumentation are never performed without arthrodesis, they are reported as add-on codes. Arthrodesis, however, may be performed in the absence of other procedures.

Example: Treatment of a burst fracture of L2 by corpectomy followed by arthrodesis of Ll-L3, utilizing anterior instrumentation Ll-L3 and structural allograft. Report as 63090, 22558-51, 22585, 22845 and 20931.

INCISION

22010 Incision and drainage, open, of deep abscess (subfascial), posterior spine; cervical, thoracic, or cervicothoracic

22015 lumbar, sacral, or lumbosacral

(Do not report 22015 in conjunction with 22010)

(Do not report 22015 in conjunction with instrumentation removal, 10180, 22850, 22852)

EXCISION

For the following codes, when two surgeons work together as primary surgeons

performing distinct part(s) of partial vertebral body excision, each surgeon should report his/her distinct operative work by appending the modifier –62 to the procedure code. In this situation, the modifier –62 may be appended to the procedure code(s) 22100- 22102, 22110-22114 and, as appropriate, to the associated additional vertebral segment add-on code(s) 22103, 22116 as long as both surgeons continue to work together as primary surgeons.

22100 Partial excision of posterior vertebral component (eg, spinous process, lamina or facet) for intrinsic bony lesion, single vertebral segment; cervical

22101 thoracic 22102 lumbar

22103 each additional segment

(List separately in addition to primary procedure)

(Use 22103 in conjunction with codes 22100, 22101, 22102) 22110 Partial excision of vertebral body for intrinsic bony lesion, without

decompression of spinal cord or nerve root(s), single vertebral segment; cervical

22112 thoracic 22114 lumbar

22116 each additional vertebral segment

(List separately in addition to primary procedure) (Use 22116 only for codes 22110, 22112, 22114)

OSTEOTOMY

For the following codes, when two surgeons work together as primary surgeons performing distinct part(s) of an anterior spine osteotomy, each surgeon should report his/her distinct operative work by appending the modifier –62 to the procedure code. In this situation, the modifier –62 may be appended to code(s) 22210-22214, 22220-22224

and, as appropriate, to associated additional segment add-on code(s) 22216, 22226 as long as both surgeons continue to work together as primary surgeons.

22206 Osteotomy of spine, posterior or posterolateral approach, three columns, one vertebral segment (eg, pedicle/vertebral body subtraction); thoracic

(Do not report 22206 in conjunction with 22207) 22207 lumbar

(Do not report 22207 in conjunction with 22206) 22208 each additional vertebral segment

(List separately in addition to primary procedure) (Use 22208 in conjunction with 22206, 22207)

(Do not report 22206, 22207, 22208 in conjunction with22210-22226, 22830, 63001-63048, 63055-63066, 63075-63091, 63101-63103, when performed at the same level)

22210 Osteotomy of spine, posterior or posterolateral approach, one vertebral segment; cervical

22212 thoracic 22214 lumbar

22216 each additional segment

(List separately in addition to primary procedure) (Use 22216 in conjunction with 22210, 22212, 22214)

22220 Osteotomy of spine, including discectomy, anterior approach, single vertebral segment; cervical

22222 thoracic 22224 lumbar

22226 each additional segment

(List separately in addition to primary procedure) (Use 22226 only for codes 22220, 22222, 22224)

FRACTURE AND/OR DISLOCATION

For the following codes, when two surgeons work together as primary surgeons performing distinct part(s) of an open fracture and/or dislocation procedure(s), each surgeon should report his/her distinct operative work by appending the modifier –62 to the procedure code. In this situation, the modifier –62 may be appended to code(s) 22318-22327, and, as appropriate, to associated additional segment add-on code 22328 as long as both surgeons continue to work together as primary surgeons. 22305 Closed treatment of vertebral process fracture(s)

22310 Closed treatment of vertebral body fracture(s), without manipulation, requiring and including casting or bracing

22315 Closed treatment of vertebral fracture(s) and/or dislocation(s) requiring casting or bracing, with and including casting and/or bracing by manipulation or traction

22318 Open treatment and/or reduction of odontoid fracture(s) and or dislocation(s) including os odontoideum), anterior approach, including placement of internal fixation; without grafting

22319 with grafting (Report required)

22325 Open treatment and/or reduction of vertebral fracture (s) and/or dislocation(s); posterior approach, one fractured vertebrae or dislocated segment; lumbar 22326 cervical

22327 thoracic

22328 each additional fractured vertebrae or dislocated segment (List separately in addition to primary procedure)

(Use 22328 in conjunction with codes 22325, 22326, 22327)

MANIPULATION

22505 Manipulation of spine requiring anesthesia, any region

PERCUTANEOUS VEREBROPLASTY and VERTEBRAL AUGMENTATION 22510 Percutaneous vertebroplasty (bone biopsy included when performed),

1 vertebral body, unilateral or bilateral injection, inclusive of all imaging guidance; cervicothoracic

22511 lumbosacral

22512 each additional cervicothoracic or lumbosacral vertebral body (List separately in addition to code for primary procedure)

22513 Percutaneous vertebral augmentation, including cavity creation

(fracture reduction and bone biopsy included when performed) using mechanical device (eg, kyphoplasty), 1 vertebral body,

unilateral or bilateral cannulation, inclusive of all imaging guidance; thoracic

22514 lumbar

22515 each additional thoracic or lumbar vertebral body (List separately in addition to code for primary procedure)